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Acting on non-communicable diseases in low- and middle-income tropical countries

Naturevolume 559pages507516 (2018) | Download Citation


The classical portrayal of poor health in tropical countries is one of infections and parasites, contrasting with wealthy Western countries, where unhealthy diet and behaviours cause non-communicable diseases (NCDs) such as heart disease and cancer. Using international mortality data, we show that most NCDs cause more deaths at every age in low- and middle-income tropical countries than in high-income Western countries. Causes of NCDs in low- and middle-income countries include poor nutrition and living environment, infections, insufficient taxation and regulation of tobacco and alcohol, and under-resourced and inaccessible healthcare. We identify a comprehensive set of actions across health, social, economic and environmental sectors that could confront NCDs in low- and middle-income tropical countries and reduce global health inequalities.

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We thank R. Beaglehole, S. Blundell, R. Nugent, F. Piel, M. Parkins and M. Thun for comments and recommendation of background literature.

Reviewer information

Nature thanks F. Assah, P. Byass, B. Singer and the other anonymous reviewer(s) for their contribution to the peer review of this work.

Author information


  1. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK

    • Majid Ezzati
    • , Jonathan Pearson-Stuttard
    •  & James E. Bennett
  2. MRC-PHE Centre for Environment and Health, Imperial College London, London, UK

    • Majid Ezzati
    • , Jonathan Pearson-Stuttard
    •  & James E. Bennett
  3. WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK

    • Majid Ezzati
  4. Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland

    • Colin D. Mathers


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M.E. designed the Review concept and wrote the Review with input from J.P.-S., J.E.B. and C.D.M. J.P.-S. contributed to clinical and epidemiological reviews. J.E.B. and C.D.M. analysed data, and J.E.B. prepared figures.

Competing interests

The authors declare no competing interests.

Corresponding author

Correspondence to Majid Ezzati.

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